A new high resolution videofluoroscopic unit has been installed and is used for our studies. We are in the process of determining the dosimetry for this new equipment from a random sample of 15 patients. We have developed a data collection format and are working with the radiation physicist in DRD who will determine the radiation exposure parameters for an average study. We completed a study of swallowing on patients with orolingual dystonia and dysphagia following botulinum toxin injection. To examine whether swallowing problems interfere with the benefits of botulinum toxin injections, blinded ratings coded vocal tract movements as dyskinetic, akinetic or normal from videofluorographic recordings made before and after treatment in 10 patients. Severe swallowing problems resulted when treatment dosages were grater than 50 units and caused lingual or laryngeal akinesias. (Ludlow, Sonies, Schulz, Rhew, ASHA, 1993) Patients with Cystinosis continue to be monitored on this protocol when they return for follow-up treatment and evaluation. By combining videofluorography and ultrasound studies we can follow the clinical course of this condition in an objective manner. Older patients on Cysteamine who have had kidney transplants appear to be maintaining their ability to swallow unlike the earlier patients who developed severe dysphagia, aspiration pneumonia and succumbed. An evaluation system has been developed to determine when to use the various imaging techniques based upon safety, risks, comfort, patient demographics (Sonies, Aspen Press, 1993). Twelve patients with dermatomyositis, polymyositis and inclusion body myositis in an intravenous Ig drug study have been evaluated to assess if overall clinical severity is related to our measures of swallowing.